Stress Response In Children Research Articles

The effects of parental presence on amygdala and mPFC activation during fear conditioning: An exploratory study.

Learning safe versus dangerous cues is crucial for survival. During development, parents can influence fear learning by buffering their children's stress response and increasing exploration of potentially aversive stimuli. Rodent findings suggest that these behavioral effects are mediated through parental presence modulation of the amygdala and medial prefrontal cortex (mPFC). Here, we investigated whether similar parental modulation of amygdala and mPFC during fear learning occurs in humans. Using a within-subjects design, behavioral (final N=48, 6-17 years, mean=11.61, SD=2.84, 60% females/40% males) and neuroimaging data (final N=39, 6-17 years, mean=12.03, SD=2.98, 59% females/41% males) were acquired during a classical fear conditioning task, which included a CS+ followed by an aversive noise (US; 75% reinforcement rate) and a CS-. Conditioning occurred once in physical contact with the participant's parent and once alone (order counterbalanced). Region of interest analyses examined the unconditioned stress response by BOLD activation to the US (vs. implicit baseline) and learning by activation to the CS+ (vs. CS-). Results showed that during US presentation, parental presence reduced the centromedial amygdala activity, suggesting buffering of the unconditioned stress response. In response to learned stimuli, parental presence reduced mPFC activity to the CS+ (relative to the CS-), although this result did not survive multiple comparisons' correction. These preliminary findings indicate that parents modulate amygdala and mPFC activity during exposure to unconditioned and conditioned fear stimuli, potentially providing insight into the neural mechanisms by which parents act as a social buffer during fear learning. RESEARCH HIGHLIGHTS: This study used a within-participant experimental design to investigate how parental presence (vs. absence) affects youth's neural responses in a classical fear conditioning task. Parental presence reduced the youth's centromedial amygdala activation to the unconditioned stimulus (US), suggesting parental buffering of the neural unconditioned response (UR). Parental presence reduced the youth's mPFC activation to a conditioned threat cue (CS+) compared to a safety cue (CS-), suggesting possible parental modulation of fear learning.

Longitudinal effects of maternal depressive and anxious symptomatology on child hair cortisol and cortisone from pregnancy to 5-years: The EDEN mother-child cohort

Exposure to maternal depressive and anxious symptomatology in utero and after birth can affect child outcomes. One proposed mechanism is through changes in child stress hormone levels, however current studies present inconsistent findings, and further research is needed to better understand the impact of maternal mental health on child stress response. This study aims to add to the limited literature by analysing longitudinal data ranging from 24 weeks amenorrhea to 5 years postpartum among 281 mother-child pairs from the French EDEN mother-child birth cohort. Hair cortisol and cortisone data were collected from children at four time points: birth, 1, 3, and 5 years. Mothers reported depressive symptomatology via the Center for Epidemiologic Studies Depression Scale (CES‐D) (at 24-weeks amenorrhea, 3-, and 5-year follow-up), and the Edinburgh Postnatal Depression Scale (EPDS) (at 4, 8 and 12 months postpartum). Prenatal anxiety symptomatology was measured via the State Anxiety Inventory (STAI) at 24 weeks amenorrhea. Group-based trajectory modelling indicated a 1-cluster classification of longitudinal child hair cortisol, cortisone and cortisol-to-cortisone ratio, as analyses did not reveal a classification by subgroups representing different child profiles. After inverse probability weighting, small effects showed prenatal depressive symptomatology was significantly associated to higher levels of child hair cortisone at one year. Prenatal anxiety symptomatology was significantly linked to higher levels of child cortisol measured at birth and cortisone at birth and at 1 year. Postpartum depressive symptomatology at 8 months was related to higher levels of cortisone among 3-year-olds. These effects were not moderated by child sex or maternal socio-economic status. Further research is needed to understand why there are associations at some time points and not others to determine any potential buffering factors.

Parental presence during induction of anesthesia in children undergoing tonsillectomy and adenoidectomy.

To investigate the effect of parental presence during induction of anesthesia (PPIA) in relieving preoperative anxiety of children undergoing tonsillectomy and adenoidectomy. One hundred and sixty children undergoing tonsillectomy and adenoidectomy were divided into the control group and the trial group. The control group received routine nursing in the operation room, while anesthesia was induced in the trial group children in the presence of their parents as part of the routine nursing. The differences in heart rate and mean dynamic pressure during pre-operative visit and anesthesia induction between the two groups were observed and recorded. The Modified Yale Preoperative Anxiety Scale (m-YPAS) and the Induction Compliance Checklist (ICC) were scored. The anxiety status of the children and their family members in the two groups was scored at different times, and the psychological stress of anesthesiologists during anesthesia induction was scored by a visual analogue scale. The differences in each index between the two groups were compared. Operation time and costs in-hospital were also compared. Compared with the control group, the heart rate and blood pressure scores as well as the ICC in the trial group were lower than those in the control group (P < 0.01). On comparing the scores of m-YPAS between the two groups, we observed that the scores of the children in the trial group were lower than those in the control group before entering the induction room and anesthesia induction (P < 0.01). There was no statistical difference between the scores of the children in the trial group and the control group on the day of operation and on the way to the operating room (P > 0.05). The nursing satisfaction scores of the family members in the trial group were significantly superior to those in the control group (P < 0.01). The scores of the visual analogue scale for psychological pressure of anesthesiologists during anesthesia induction were higher in the trial group than in the control group (P < 0.05). The operation time and costs in study group were both significantly higher than those of control group (P < 0.05). PPIA can significantly reduce preoperative anxiety and surgical physiological stress response in children undergoing tonsillectomy and adenoidectomy, and it is worth being encouraged.

Comparative study of the analgesic and anti-stress effect of inhalation anesthesia in children with cancer and trauma pathology during surgical treatment

Background. Adequate anesthesia is of great importance for patient safety, it reduces stress reactions to surgery and trauma. The perfection of modern anesthesia allows performing complex operations in different age periods in patients at high surgical and anesthetic risk. To limit the activation of neuroendocrine, inflammatory and immune reactions during surgery, new methods of anesthesia are constantly being searched for, different inhalation and non-inhalation drugs for anesthesia are compared in order to find an ideal “stress-free” anesthetic. Currently, during cancer surgeries, sevoflurane is widely used, but there are few studies showing efficiency of this inhalation anesthetic in children during surgical treatment of tumors and its effect on operative trauma and the reaction of the child’s body to stress. The purpose of our research is to study the extent to which sevoflurane limits the activation of neurovegetative, inflammatory, and immune responses in children during cancer surgery. Materials and methods. Twenty-seven children (first group) aged from 1 to 17 years (6.04 ± 5.84 years), who came for surgical treatment of cancer, were examined. To compare the studied indicators, 23 children (second group) aged from 2 to 17 years (10.68 ± 4.21 years) were additionally examined, they were scheduled for surgical treatment of trauma pathology. Results. Evaluation of the adequacy of sevoflurane anesthesia during operations in cancer and trauma patients showed that most hemodynamic parameters had similar changes at all stages, which is typical for this type of anesthesia. We studied changes in C-reactive protein and circulating cytokines before and after anesthesia with sevoflurane in children with cancer and trauma pathology. C-reactive protein level increased 4 times, but initially its level was 2–2.5 times higher in cancer patients. Similar dynamics was demonstrated with pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor). By the end of surgical intervention, a significant increase of cortisol was noted; however, in the children of the second group, the level of this hormone increased more compared with cancer patients. All spectral indicators of heart rate variability, which testified to the tension of the autonomic nervous system, had a significant difference between the groups. Conclusions. During inhalation anesthesia with sevoflurane, the profile of stress response in children with cancer differs from that in patients with trauma pathology.

Cognitive Predictors of Posttraumatic Stress in Children 6 Months after Paediatric Intensive Care Unit Admission

This study aimed to identify predictors, especially cognitive predictors, of posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD) in children 6 months after Paediatric Intensive Care Unit (PICU) admission. Participants were 55 children aged 6–16, admitted to PICU for at least 8 h. Medical data were collected from patient charts. Cognitive variables (peri-trauma affect, cognitive processing and trauma memory) were assessed by interview and self-report questionnaires 2–4 weeks and 6 months following PICU admission. Acute PTSS at 2–4 weeks were assessed by self-report questionnaire and PTSD at 6 months was assessed by clinical interview. Receiving ketamine in PICU was the only non-cognitive variable associated with PTSS at 6 months. Peri-trauma affect, cognitive processing, and trauma memory significantly and independently accounted for 21% of the variance in PTSS at 6 months even after controlling for acute PTSS (and ketamine). A mediation analysis showed that peri-trauma affect indirectly influenced PTSS at 6 months through its effect on cognitive processing. Conclusions: Cognitive variables significantly contribute to PTSS in children, following PICU admission. Peri-trauma affect influenced PTSS only via disrupted cognitive processing. Prevention or early intervention strategies aimed at helping children develop a complete, contextual trauma narrative may be effective in reducing persistent posttraumatic stress responses in children following PICU.

Atypical maternal interaction is associated with elevated levels of hair cortisol in children.

The quality of maternal caregiving is an important factor in the healthy development of a child. One consequence of prolonged insensitive and atypical maternal interaction behavior (e.g., withdrawing from interactions with the child and role-reversal, i.e., the takeover of the parental role or parts of it by the child) in mother-child-dyads can cause alteration of the child's stress response system. Higher salivary cortisol concentrations were reported in infants and toddlers directly after negative interactions with their parents. However, no study to date has examined the association between atypical maternal interaction behavior and hair cortisol concentrations (HCC) in infants. Here, we studied the association of maternal interaction behavior with HCC of the child. Mother-child dyads (N = 112) participated in the longitudinal study My Childhood-Your Childhood. The AMBIANCE scale and its subscales were used to assess atypical maternal interaction behavior during the Strange Situation Procedure. Chronic stress levels in the child were assessed by HCC of 3 cm hair strands at the age of 12 months. Maternal educational level (operationalized in highest education level) served as a control variable. Robust multiple linear regression analyses revealed that role/boundary confusion was associated with HCC, i.e., the higher atypical interaction behavior of the mother the higher the HCC in the children. By measuring hair cortisol in this study, it is possible to determine the average long-term activity of the child's stress response system.Thus, atypical maternal interaction behavior could be a risk factor for persistent stress in children, contributing to a higher risk for negative health outcomes in later life. The results of this study highlight the importance of early intervention programs that focus on the relationship between mother and child.

Effects of propofol combined with remifentanil on hemodynamics and stress response in children undergoing surgery for oral cancers, tonsil and adenoid surgery

The anesthetic medication to sedate a child during general anesthesia (GA) for oral cancer, adenoidectomy or tonsillectomy is associated with operative complications such as hemodynamic instability and long postoperative recovery period. The current advancement enables combination of different anesthetic medications to decrease operative or postoperative complications associated with GA. In this study assessed the effects of propofol combined with remifentanil on hemodynamics and stress response in children undergoing oral cancer, tonsil and adenoid surgery. Propofol combined with remifentanil is beneficial to anesthesia for children undergoing oral cancer tonsil and adenoid surgery, manifested as stable hemodynamics, rapid recovery, low inflammatory and stress responses, and mild adverse reactions. A total of 106 eligible children treated from May 2017 to December 2019 were randomly divided into observation and control groups (n=53). Observation group was anesthetized by propofol plus remifentanil, while control group was anesthetized by propofol plus esketamine. Mean arterial pressure (MAP), heart rate (HR), serum C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), epinephrine (E), cortisol (Cor), CD3+, CD4+ helper and CD8+ inhibitory T lymphocytes, and CD4+/CD8+were compared before anesthesia induction (T1), immediately after intubation (T2), at the beginning of operation (T3), at the end of operation (T4) and 5 min after extubation (T5). Time of anesthetic recovery and adverse reactions after extubation were observed. MAP and HR significantly rose at T2 compared with those at T1. After maintenance of anesthesia, MAP and HR were significantly lower in observation group than those in control group. Serum CRP, IL-6 and TNF-α levels rose with time. E and Cor levels rose from T1 to T4 and declined at T5, with significant differences at each time point. CRP, IL-6, TNF-α, E and Cor levels were lower in observation group from T3 to T5. At T4 and T5, CD3+, CD4+levels and CD4+/CD8+ declined, whileCD8+level rose compared with those at other three time points. Time of recovery of autonomous respiration and limbs and duration from anesthetic withdrawal to extubation were significantly shorter in observation group. Observation group had lower incidence rate of dysphoria during recovery.

Analysis of the Effect of Laparoscopic and Open Surgical Treatment in Children with Congenital Megacolon.

In this paper, we have compared and analyzed the effect of laparoscopic and open surgical treatments in children with congenital megacolon. To address this, a total of 64 children with congenital megacolon who underwent surgery in the hospital, particularly from April 2014 to December 2020, were selected as the research objects. They were divided into control and observation groups by the random number table method, with 32 cases in each group. The control and observation groups were treated with open surgical and laparoscopic treatments, respectively. The treatment effects of the two groups were compared. The enema time, operation time, blood loss, anal defecation time, and duration of postoperative hospital stay of the observation group were lower than those of the control group. The comparison between the two groups was statistically significant (P < 0.05). There was no significant difference in CRP and WBC between the two groups before surgery (P > 0.05). The CRP level and WBC of the two groups were both increased after operation, the CRP level of the observation group was lower than that of the control group, the difference was statistically significant (P < 0.05), the WBC of the two groups was not statistically significant (P > 0.05). The rate of excellent and good defecation in the observation group on the 7th day after surgery was higher than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in Krickenbeck scores between the two groups before surgery (P > 0.05); 6 months after the surgery, the score of Krickenbeck in both groups increased, and that of the observation group was higher than that of the control group, indicating a difference in the overall score (P < 0.05). The total complication rate within 7 days after surgery in the observation group was lower than that in the control group, and the difference was not statistically significant (P > 0.05). Laparoscopic treatment of congenital megacolon could improve surgical indicators and reduce stress response in children, improve defecation and anal function, reduce the risk of complications, and promote recovery.

Potential role of salivary cortisol levels to reflect stress response in children undergoing congenital heart surgery.

This study aimed to provide baseline information on the potential role of salivary cortisol in reflecting the stress response in children undergoing congenital heart surgery. Children underwent congenital cardiac surgery, aged between one and seventeen years were included. Saliva samples were collected pre- and postoperatively by the health caregiver immediately after the children woke up (07:00-09:00 am) and at 06:00 pm in the evening. Salivary cortisol levels were compared with the reference index values from a large database. Median baseline preoperative morning salivary cortisol levels were significantly lower than the reference values in both < 5-year-old females (p = 0.01) and males (p = 0.04) and in males between 11 and 20 years of age (p = 0.01). Median baseline preoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5 and 10 years of age (p = 0.04) and in between 11- and20-year-old males (p = 0.01). Median postoperative morning salivary cortisol levels were significantly lower than the reference value in both < 5-year-old females (p = 0.01) and males (p = 0.04) and females between 5 and 10 year of age (p = 0.04). Median postoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5- and 10-year-old females (p = 0.04). Diurnal variability of salivary cortisol levels in children undergoing congenital heart surgery may be different from normal reference values both in preoperative and postoperative periods that can be a predictive indicator of anxiety on pre- and postoperative period for children that undergoing cardiac surgery.

Trauma exposure and mental health outcomes among Central American and Mexican children held in immigration detention at the United States-Mexico border.

We explored the associations between early-life adversity and migration-related stress on the mental health of Central American and Mexican migrating children held in United States immigration detention facilities. Migrating children have high rates of trauma exposure prior to and during migration. Early-life adversity increases risk for developing mental health disorders. Forced separation of migrating children from their parents at the United States-Mexico border potentially exacerbates this risk. We sought to determine whether exposure to trauma prior to immigration and specific features of immigration detention were associated with posttraumatic stress symptomatology. We interviewed parents of 84 migrating children (ages 1-17) after families were released from immigration detention facilities to assess children's migration- and detention-related experiences. A modified version of the University of California Los Angeles Posttraumatic Stress Disorder (PTSD) Reaction Index was administered to assess children's PTSD symptoms and document trauma exposure. A total of 97.4% of children experienced at least one premigration traumatic event. PTSD symptom severity was most strongly predicted by premigration trauma and duration of parent-child separation. This study contributes to a growing empirical literature documenting that early-life adversity increases risk of developing mental health disorders, particularly following additional stress exposure, and that remaining with parents during immigration detention may help mitigate children's stress response.

Effects of ultrasound-guided brachial plexus block combined with laryngeal mask sevoflurane general anesthesia on inflammation and stress response in children undergoing upper limb fracture surgery.

article: Effects of ultrasound-guided brachial plexus block combined with laryngeal mask sevoflurane general anesthesia on inflammation and stress response in children undergoing upper limb fracture surgery - Minerva Pediatrics 2021 Dec 21 - Minerva Medica - Journals

Emotional Availability as a Moderator of Stress for Young Children and Parents in Two Diverse Early Head Start Samples.

Positive parent-child relationship quality is critical for buffering children from the effects of stress on development. It is thus vital to develop interventions that target parent-child relationship quality for families experiencing stress. We examined the moderating role of parent-child relationship quality (as measured by parental emotional availability [EA]) in the intergenerational association between parental adverse childhood experiences (ACEs) and their young children's hair cortisol concentrations (HCCs)-a physiological marker of cumulative hypothalamic pituitary adrenal (HPA)-axis activity. Using data from 127 parent-child dyads collected by two of six ACF-funded Buffering Toxic Stress consortium sites, we tested interaction effects of parental ACEs with parental EA on young children's (Mage = 18.38, SDage = 7.10) HCC. Results revealed curvilinear main effects such that higher parental ACEs were significantly associated with greater HCC and stronger associations occurred at higher levels of parental ACEs. However, this association was moderated by parental EA. Thus, among children with higher parental history of ACEs, children of parents with higher EA had lower HCC compared to children of parents with lower EA. These findings provide support for the risk-buffering and risk-exacerbating role of parent-child relationship quality (e.g., EA) for the transmission of parents' early life adversity on their children's HPA-axis activity, documented here in a racially and ethnically diverse sample of children and parents served by Early Head Start. Findings suggest that intervention and prevention efforts targeting stress response in children of mothers with childhood adversity should also support parents in building an emotionally available relationship with their children.

Ethogram of non-verbal behaviours associated with emotional regulation and stress response in children and adolescents with complex trauma

Abstract Complex trauma is a clinical concept developed to address the nature and effects of interpersonal traumatic experiences over the development of children and adolescents. To contribute to the development of ecologically valid diagnostic tools and a better understanding of the effects of complex trauma, an ethogram of emotional regulation and stress response behaviours was proposed and used as the main instrument in the Crossed-Puzzles Game. In total 84 children and adolescents aged 6–14 (50% of children with complex trauma in state protective care) were selected from institutions and the community. Both groups were matched by age, sex, and socioeconomic status. PCA, PERMANOVA, Mann-Whitney’s U, Pearson correlations, and logistic regression analyses were performed. The ethogram’s category ‘Externalising of frustration’ was identified as one of the strongest predictors for the complex trauma group. The ethogram’s validity as a research and assessment instrument from a clinical ethology perspective of complex trauma in psychology was discussed.

Effect of animal assisted interactions on activity and stress response in children in acute care settings

ObjectiveDetermine the effects of animal assisted interactions (AAI) on activity and stress response in pediatric acute care settings. DesignRandomized treatment control design. SettingInpatient pediatric acute care units (PICU, CVICU and Hematology/Oncology). PatientsEighty pediatric inpatients (49% male) age 2–19 years. InterventionThe AAI experimental group patients interacted with therapy dog teams for 5–10 min and the comparison group patients continued their current activity without an AAI visit. Measurement and resultsSalivary cortisol, activity level, and mood were assessed before and after AAI. AAI was associated with a decrease in cortisol levels and increases in mood and activity. ConclusionAAI benefits children in pediatric acute care units.

Caregiving quality modulates neuroendocrine and immunological markers in young children in foster care who have experienced early adversity.

Early adversity is believed to alter the body's stress-response systems, putting children at increased risk for somatic and mental health problems. However, it remains unclear whether such alterations normalize under improved caregiving experiences. Thus, the goal of the present study was to investigate (a) whether children in foster care show endocrine and immunological alterations relative to children living with their biological families, (b) whether these alterations change over time spent with the foster family, and (c) whether the alterations are modulated by current caregiving experiences. A total of 94 children in foster care and 157 biological children, aged two to seven years, took part in a longitudinal study with three assessments conducted over a 12-month study period. At the initial assessment, children lived for an average of 18 months with their current foster families. Children's cortisol, dehydroepiandrosterone (DHEA) and progesterone concentrations and cortisol/DHEA ratios were measured in scalp hair and children's secretory immunoglobulin A (sIgA) levels in saliva. Caregiving quality was assessed based on caregiver-reports and observational measures of caregiver-child interactions. Children in foster care had lower cortisol/DHEA ratios and higher progesterone concentrations than biological children, while no group differences were found for cortisol, DHEA or sIgA. Time spent with the current foster family did not significantly influence the child's endocrine or immunological markers. Importantly, caregiving quality modulated cortisol/DHEA ratios and sIgA concentrations: children in foster care of lower caregiving quality had lower cortisol/DHEA ratios than children in foster care of higher caregiving quality and showed decreasing, rather than increasing, sIgA concentrations across the study period. Our results indicate that caregiving quality in the foster family may have an important modulating effect on selected indicators of the child's stress response and could thereby mitigate the possible consequences of early childhood adversity.

Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.

Cardiac surgery (CS) in pediatric patients induces an overt oxidative stress (OS) response. Children are particularly vulnerable to OS related injury. The immaturity of their organs and antioxidant systems as well as the induction of OS in cardio-pulmonary bypass (CPB) surgery may have an important impact on outcomes. The purpose of this study was to describe the OS response, measured by urinary free 8-iso-PGF2α, in infants undergoing CS and to evaluate the relationship between OS response and post-operative clinical outcomes. Infants with congenital heart disease undergoing CS with or without CPB were eligible for enrollment. Children were classified as neonates (<30 days) or infants (30 days-6 months) based on the age at surgery. Perioperative continuous non-invasive neuromonitoring included amplitude-integrated electroencephalogram and cerebral regional oxygen saturation measured with near-infrared spectroscopy. Urine 8-iso-PGF2α levels were measured before, immediately post-, and 24-hours post-surgery, and the 8-iso-PGF2 clearance was calculated. Sixty-two patients (60% neonates) were included. Urine 8-iso-PGF2α levels 24 hours after surgery (8.04 [6.4-10.3] ng/mg Cr) were higher than pre-operative levels (5.7 [4.65-7.58] ng/mg Cr) (p<0.001). Those patients with a severe degree of cyanosis caused by Transposition of the Great Arteries (TGA) had the highest post-operative 8-iso-PGF2α levels. Patients with intra-operative seizures had higher post-operative 8-iso-PGF2α levels. 8-iso-PGF2α clearance at 24 hours post-surgery was different between newborns and infant patients, and it was inversely correlated with days of mechanical ventilation (p = 0.05), ICU LOS (p = 0.05) and VIS score at 24 hours (p = 0.036). Children undergoing CS, particularly neonatal patients, experience a significant post-operative OS response that might play an important role in postoperative morbidity. TGA patients undergoing arterial switch operations demonstrate the highest post-operative OS response. Rapid clearance of isoprostanes, which occurs more frequently in older patients with more mature antioxidant systems, might be associated with better clinical outcomes.

INFLUENCE OF INTRAOPERATIVE FLUID THERAPY ON STRESS RESPONSE IN PAEDIATRIC ORTHOPAEDIC SURGERY

Introduction. Optimization of the intraoperative fluid therapy is one of the elements of the ERAS program. The strategy of avoiding fluid overload has shown positive results in adults, but still remains unexplored in children. Fluid requirements in children are higher than in adults and they vary with age. It’s still not clear whether it is possible or not to extrapolate the data of studies obtained in adults to children and to use similar recommendations. The aim of this study is to compare intraoperative fluid approaches from the point of view of surgical stress response in children undergoing orthopaedic surgery. Material and Methods: The study included 60 pediatric patients over 1 year of age who had undergone orthopaedic surgery. Рatients were stratified into two groups depending on the volume of intraoperative base crystalloid infusion. First group of patients received &lt;7 ml/kg/h crystalloids, and the second group of patients received &gt; 7 ml/kg/h. We evaluated intraoperatively changes of blood pressure, heart rate, urine output, Hb, Ht, blood glucose, acidbase status. After surgery we estimated lactate, insulin, insulin resistance index HOMA-IR (homeostatic model assessment) and insulin sensitivity index QUICKI. Mean data was compared with Mann-Whitney U-test. Results of the study: After stratification two groups were identified. The first group of patients (n=30) received 10.7 ± 3.03 ml/kg/h and the second one 2 (n=30) – 5.07 ± 1.15 ml/kg/h of intraoperative crystalloid fluids as a basic fluid therapy. We did not find significant changes in blood pressure, heart rate, Hb, Ht, acid-base status in both groups. But the urine output was decreased in the group 2 (0.43 ± 0.59 ml/kg/h) in comparison with the group 1 (1.16 ± 0.89, p=0.009). The concentration of blood glucose was insignificantly increased in both groups, but the level of insulin and HOMA-IR was significantly higher in group 2 (insulin 5.39 ± 3.93 vs 8.94 ± 6.15 mU/L, p=0.006; HOMAIR 1.30 ± 1.05 vs 2.39 ± 2.14, p=0.004), and index QUICKI was lower (0.39 ± 0.05 vs 0.35 ± 0.04, p=0.004). We also found the tendency to lactation increase in group 2 (1.46 ± 0.62 vs 1.90 ± 0.69, p=0.07), even though that was not significant. Conclusion: This study revealed the tendency to insulin resistance of tissues as one of the signs of a surgical stress response in children who were limited in intraoperative fluid therapy during orthopaedic surgery. Results of the study suggest that the limitation of intraoperative fluids is not applicable for children, and the volume of base crystalloids must be more than at least 7 ml/kg/h during paediatric orthopaedic surgery. Further research is necessary to determine what minimum volume is acceptable in other types of paediatric surgeries.

Primary antibody deficiency: The impact on the quality of life and mental health of affected children and their parents.

To evaluate health-related quality of life, mental health and treatment-related stress responses in children with primary antibody deficiency and both their parents. Children and their parents completed the standardised questionnaires Pediatric Quality of life Inventory, Strength and Difficulties Questionnaire and Impact of Event Scale. Parents also completed standardised questionnaires regarding their own mental health and quality of life. The results were compared to those of healthy children, kidney transplanted children and children in remission from acute lymphoblastic leukaemia. Children with primary antibody deficiency reported a poorer health-related quality of life compared to healthy children and children in remission from acute lymphoblastic leukaemia. They reported poorer mental health compared with healthy children. Mothers of children with primary antibody deficiency reported poorer mental health compared to mothers of healthy children but comparable to mothers of chronically ill children. Parents reported a similar quality of life as the general Norwegian population. Treatment with subcutaneous immunoglobulin infusions at home is generally well tolerated, but some report severe treatment-related stress. Primary antibody deficiency has a significant impact on quality of life and mental health of affected children. Patients and parents with severe treatment-related stress should be identified and helped.

Detection of Subtle Stress Responses in Children with Severe Motor and Intellectual Disabilities due to Changes of Facial Muscles

Detection of Subtle Stress Responses in Children with Severe Motor and Intellectual Disabilities due to Changes of Facial Muscles

Latent profiles of children's autonomic nervous system reactivity early in life predict later externalizing problems.

Prior researchers have observed relations between children's autonomic nervous system reactivity and externalizing behavior problems, but rarely considers the role of developmentally regulated changes in children's stress response systems. Using growth mixture modeling, the present study derived profiles of parasympathetic nervous system reactivity (as indicated by respiratory sinus arrhythmia (RSA)) and sympathetic nervous system reactivity (as indicated by pre-ejection period (PEP)) from low income, primarily Mexican American children measured repeatedly from infancy through age 5 (N=383) and investigated whether profiles were associated with externalizing problems at age 7. Analyses identified two profiles of RSA reactivity (reactive decreasing and U-shaped reactivity) and three profiles of PEP reactivity (blunted/anticipatory reactivity, reactive decreasing, non-reactive increasing). Compared to children with an RSA profile of reactive decreasing, those with an RSA profile of U-shaped reactivity had marginally higher externalizing problems, however, this difference was not statistically significant. Children who demonstrated a profile of blunted/anticipatory PEP reactivity had significantly higher externalizing problems compared to those with a profile of non-reactive increasing, likely related to the predominantly male composition of the former profile and predominantly female composition of the latter profile. Findings contribute to our understanding of developmental trajectories of ANS reactivity and highlight the utility of a longitudinal framework for understanding the effects of physiological risk factors on later behavior problems.